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The Prioritized List

The Prioritized List

Learn how the Prioritized List of health Services helps determine what services the Oregon Health Plan (OHP) covers.

Questions and answers about the Prioritized List

For detailed information about the creation of the Prioritized List, see the Health Evidence Review Commission's (HERC) Brief History of Health Services Prioritization in Oregon or the biennial reports to the Oregon legislature on the HERC reports page.

Answer
How does the Prioritized List work?
The Oregon Health Evidence Review Commission (HERC) ranks health care condition and treatment pairs in order of clinical effectiveness and cost-effectiveness.
The Prioritized List emphasizes prevention and patient education. In general:
  • Treatments that help prevent illness are ranked higher than services that treat illness after it occurs.
  • OHP covers treatments that are ranked on a covered Prioritized List line for the client's reported medical condition.
What lines are currently covered on the Prioritized List of Health Services?

Effective Jan. 1, 2012, the OHP covers Prioritized List lines 1 through 498.

Where do I find past, current and proposed Prioritized Lists of Health Services?
Use the following links on the HERC website. You can also eSubscribe to receive e-mail updates from HERC whenever Prioritized List information changes or view all recent HERC updates.
Where can I learn more about Prioritized List coverage?
For DMAP policies related to Prioritized List coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.
 
To find out whether a specific procedure is potentially covered according to the Prioritized List, providers can use the HSC List inquiry  on the Provider Web Portal at https://www.or-medicaid.gov or call the Benefit RN Hotline at 800-393-9855 or 503-945-5939 (Salem).
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Recent Prioritized List updates

Also visit the main HERC website and eSubscribe to receive updates from HERC when updates occur.​​​​

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